American journal of medical quality : the official journal of the American College of Medical Quality
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The authors' goal was to determine the rate at which emergency physicians document confirmation of endotracheal tube (ET) placement. The study was conducted in a 60 000-visit emergency department (ED) of an urban tertiary referral hospital. The authors' airway registry database was used to identify patients requiring airway management; 433 patients met study criteria, 281 (65%) were intubated in the ED, and 152 (35%) were intubated prior to arrival. ⋯ The rate was higher for patients intubated by emergency medical services (40/64 [63%]) than for interhospital transfers (12/88 [14%]) (P < .0001). Documentation of ET placement has implications for patient care and safety. This study indicates that educational interventions are warranted to improve physicians' awareness of the importance of documenting correct tube placement.
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Perceptions of organizational commitment to safety differ between the operating rooms in high- and medium-complexity facilities of the Veterans Health Administration (VHA). The purpose of this study was to see whether medical team training (MTT) reduced this difference. The Safety Attitudes Questionnaire was administered before and at the completion of a MTT program. ⋯ Before MTT, respondents working at medium-complexity facilities had more favorable perceptions of knowledge of proper channels and encouragement by colleagues to report safety concerns than respondents who work at high-complexity facilities. At completion, there was no difference in perceptions between respondents working at high- and medium-complexity facilities for these items. The VHA MTT program improved perceptions at both high- and medium-complexity facilities and eliminated differences present at baseline.
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This study's purpose was to describe compliance with established venous thromboembolism (VTE) prophylaxis guidelines in medical and surgical inpatients at US academic medical centers (AMCs). Data were collected for a 2007 University HealthSystem Consortium Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) Benchmarking Project that explored VTE in AMCs. Prophylaxis was considered appropriate based on 2004 American College of Chest Physicians guidelines. ⋯ Surgical patients admitted from the emergency department and with higher illness severity were more likely to receive appropriate prophylaxis. Despite guidelines, VTE prophylaxis remains underutilized in these US AMCs, particularly among surgical patients. Because AMCs provide the majority of physician training and should reflect and set care standards, this appears to be an opportunity for practice and quality improvement and for education.
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Recent health care improvement initiatives have linked financial payments to compliance with predetermined performance measures. This article reports the effect of a unique prophylactic antibiotic use program on compliance rates and costs. The Departments of Surgery, Infection Control, and Anesthesiology collaborated on a prophylactic preoperative antibiotic protocol, whereby Anesthesiology assumed responsibility for timely antibiotic prophylaxis (TAP) before surgical incision. ⋯ Factors associated with TAP failure included >60 minutes from anesthesia induction to surgical incision (P < .001), surgical procedure (P < .001), specific antibiotic administered (P < .001), and individual anesthesia provider (P < .001). The ROI was 2.2. TAP compliance rates increased after Anesthesiology assumed responsibility, with anesthesia providers being a significant factor.